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. 2011 May;22(5):967-74.
doi: 10.1681/ASN.2010080863. Epub 2011 Apr 14.

Arterial remodeling associates with CKD progression

Marie Briet  1 , Cédric Collin, Alexandre Karras, Stéphane Laurent, Erwan Bozec, Christian Jacquot, Bénédicte Stengel, Pascal Houillier, Marc Froissart, Pierre Boutouyrie; Nephrotest Study Group
Collaborators, Affiliations

Arterial remodeling associates with CKD progression

Marie Briet et al. J Am Soc Nephrol. 2011 May.

Abstract

In CKD, large arteries remodel and become increasingly stiff. The greater pulsatile pressure reaching the glomerulus as a result of increased aortic stiffness could induce renal damage, suggesting that the stiffening and remodeling of large arteries could affect the progression of CKD. We measured carotid-femoral pulse wave velocity, aortic pressure and carotid remodeling and stiffness parameters in 180 patients with CKD (mean measured GFR, 32 ml/min per 1.73 m(2)) and followed them prospectively for a mean of 3.1 years. During follow-up, carotid stiffness significantly increased (+0.28 ± 0.05 m/s; P<0.0001) but aortic stiffness did not. Carotid intima-media thickness decreased significantly during follow-up and the internal diameter of the carotid increased, producing increased circumferential wall stress (+2.08 ± 0.43 kPa/yr; P<0.0001). In a linear mixed model, circumferential wall stress significantly associated with faster GFR decline after adjustment for risk factors of cardiovascular disease and progression of CKD. In a multivariable Cox model, carotid circumferential wall stress and pulse pressure independently associated with higher risk for ESRD. None of the arterial stiffness parameters associated with progression of CKD. In conclusion, maladaptive remodeling of the carotid artery and increased pulse pressure independently associate with faster decline of renal function and progression to ESRD.

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Figures

Figure 1.
Figure 1.
Study flowchart.
Figure 2.
Figure 2.
Higher values of circumferential wall stress associate with increased risk of ESRD. Comparisons between survival curves were significant (log rank test, P = 0.0003).
See this image and copyright information in PMC

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